NPIMap

Organization Active NPI

Graham Hospital District

  • Surgery Physician
  • Graham, TX
National Provider Identifier
1972950467
Registry record updated Jan 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
GRAHAM HOSPITAL DISTRICT
Practice address
1301 Montgomery Rd
Graham, TX 76450-4240
Phone
(940) 549-3400
NPI assigned
May 16, 2016
Last updated
Jan 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shane Kernell
Title
Ceo
Phone
(940) 549-3400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary
General Practice Physician 208D00000X 100252 TX

Addresses

Primary practice location

1301 Montgomery Rd
Graham, TX 76450-4240

Mailing address

1301 Montgomery Rd
Graham, TX 76450-4240
Phone (940) 549-3400

Other identifiers 1

IdentifierTypeStateIssuer
401018301MedicaidTX

Other names 1

  • Graham Regional Physicians Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161229000390 TX Part B Supplier - Clinic/Group Practice 8123246469 Receives reassigned benefits from 8 practitioners
Practice locations: Graham, TX

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Graham Hospital District Dba Graham Regional Hospice4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Graham Regional Medical CenterGraham, TX, CCN 450085 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2014
Graham Regional Medical CenterGraham, TX, CCN 45U085 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2014
Graham Regional Medical CenterGraham, TX, CCN 671300 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Feb 1, 2014
Jan 1, 2023

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672790400000",
    "number": "1972950467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 MONTGOMERY RD",
            "city": "GRAHAM",
            "state": "TX",
            "postal_code": "764504240",
            "telephone_number": "940-549-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 MONTGOMERY RD",
            "city": "GRAHAM",
            "state": "TX",
            "postal_code": "764504240",
            "telephone_number": "940-549-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAHAM HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-16",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A",
        "authorized_official_last_name": "KERNELL",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "940-549-3400"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "100252",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "401018301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Graham Regional Physicians",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Graham Regional Physicians",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Graham, TX

Sources for this page

Verify at the official NPI Registry.